Volume and Vision in Vascular Care

Joe Cantlupe, for HealthLeaders Media , October 5, 2011
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The importance of timely interaction for a ruptured abdominal aortic aneurysm is reflected by mortality rates, says Michael Dalsing, MD, a vascular surgeon with IU Health. Nationally, about 50% of patients afflicted with ruptured abdominal aortic aneurysm survive. The rapid-response procedure has resulted in lower mortality rates of 18% to 25%, he says.

The process utilized by IU Health Methodist in Indianapolis is what hospital officials term the “one-call streamline” system. When emergency department physicians evaluate and diagnose a vascular emergency, a number of quick responses occur. The hospital has the ability to review
CAT scans on a secure website even before the patient is transferred from the ED, says Dalsing. “The accepting surgeon is then able to form the patient’s treatment plan and to arrange necessary support teams for the patient’s arrival at Methodist.” The approach enables the patient to go from a helicopter landing pad or triage ambulance directly to the operating room when appropriate.

Dalsing and a colleague wrote in an internal hospital review that there is a need for common protocols for process improvement at the national level and further creation of of specialized centers for treating aortic aneurysms.

Success Key No. 2: Evaluating the competition

Boca Raton (FL) Regional Hospital is a 394-staffed-bed tertiary hospital where leadership believed it needed to improve its vascular care program to adapt to an increasingly aging patient population, and especially to compete against larger tertiary care facilities. Creating an aortic center was a way to achieve its goals, officials say. 

Within the past couple of years it revamped its program by hiring a new physician leadership team, investing in new programs and revising protocols to expand its treatment and diagnosis management of vascular care. “The message is, you have a problem and get it addressed right away,” says Lee, director of the endovascular program, referring to the hospital’s strategic management plan to address competitive challenges in vascular care.

By developing an aortic center that provides immediate and 24/7 assistance to local hospitals and physicians for rapid diagnosis and treatment of aortic emergencies, Boca Raton improved its care and improved its bottom line, Lee says.

In the past year, Boca has reaped a return on seeing the number of patients for complicated aortic conditions increase by about 50%, says Lee. There were 60 aortic cases and it increased to 90 cases, he says. “If you look at a 50% increase in volume in just one year, that represents an impressive figure by any standards,” Lee says.

A multidisciplinary team works to offer a full spectrum of open surgical and minimally invasive procedures, while surgeons and electrophysiologists work collaboratively, Lee says. The specialized cardiovascular ICU is for patients who have had open heart, vascular, and thoracic surgical procedures.

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